Structure in Uncertainty: we still need routines

Posted on Thu 7 May 2020

Written by Lauren Leahy

If there is one thing 2020 has taught us, it’s that everything can change in an instant. Such constant change can be unsettling, especially for people with disabilities or who are on the autism spectrum.

Before the pandemic, you and your family probably had many routines. They give the day structure, ensure that everyone knows what is expected of them, and generally help us maintain our sanity. But how can we have any semblance of a routine when the world is changing daily, when people are working from home (or out of work), schooling is happening through computers, and we can’t visit friends and family anymore?

Here, CPA therapists, Belinda Cluff (Speech Pathologist) and Melinda Conroy (Occupational Therapist [OT]), share their insights on how we can all maintain a level of normalcy at this time.

What is a routine and why does routine matter?

According to RaisingChildren.net.au, “Routines are how families organise themselves to get things done, spend time together and have fun… they help family members know who should do what, when, in what order and how often.” Routines can take place every day – such as mealtimes and getting ready for bed – or they can occur weekly or only occasionally, like medical appointments or play dates.

CPA Speech Pathologist, Belinda Cluff, agrees that routines are an essential part of life.

“Routines offer both children and adults a structure and understanding of what will happen in their day. It makes their day predictable, safe and secure. Without a structure, people may be unsure of what is coming next in the day and you may see behaviours driven by emotions like anxiety or anger stemming from uncertainty,” she says.

“A good way to think of this is when you have been driving and you came across a roadblock or a detour. How did you feel about having to go another way? Did you get butterflies in your belly? Did you clench your teeth a bit harder?”

Melinda Conroy (OT) agrees, saying “This is the way children develop a foundational understanding of predictability, meaning the sequence of what happens during their day and night, and what is expected of them. That understanding of predictability continues into adulthood.”

“When things happen in the same sequence, people are not learning a new pattern every day, which allows them to build on previous learning and experiences,” says Melinda.

Belinda adds: “It also reminds people that a certain event will end, particularly if it is something they are not too keen on!”

Why are routines especially important for those with disabilities?

While routines in some form are important for all of us, they may be even more important for those with disability, who often need regular medicines or medical procedures, or who may have particular goals in terms of skill development that require daily practice.

People with ASD can also find changes in routine particularly upsetting. Their routines are often part of how they comfort themselves and changing them can create very high levels of anxiety.

How can I maintain a routine during a pandemic?

You can access a free downloadable routine template from the CPA website. There are templates for families with children, teens, and adults.

RaisingChildren.net.au recommends establishing the goal of the routine, listing the individual steps in order, and working out the time needed. When working with children or those with more complex needs, you should work out what they can do independently, and where you need to help. You should also consider anything that may get in the way of the routine’s success – such as TV and other distractions – any house rules that need to be reinforced, and how an element of fun can be included.

"Some people may need additional strategies to support them with moving through steps of a routine,” says Melinda. Strategies can include:

Verbal cues (e.g. saying “it’s time to brush your teeth”)

Physical cues (e.g. a touch on the shoulder to prompt moving on to the next step)

Visual supports (e.g. pictures of the steps in a routine, even just with sticky notes or drawings)

Social StoriesTM(customised books with photos to describe the specific events for a new routine).

Belinda suggests involving everyone who will use the routine in developing these strategies as much as possible, such as asking them to help put together a visual chart.

“This gives each person ownership over the routine and they are more likely to follow it,” she says. “If your visual allows for the pieces to be moved to a ‘finished’ side, it enables people to have a clear start and ending to activities.”

The most important part of a routine is flexibility

Both Belinda and Melinda agree the most important part of a routine is flexibility. As Melinda says, “What works effectively for a person or family at one point in time might not always be a ‘good fit’.” Circumstances change. Pandemics happen. Or people just have ‘off’ days.

“If you are having a great time doing an activity, don’t stop just because it is time for the next one,” says Belinda. “Routines give your day structure, but you still need to have fun.”

Download CPA’s free routine templates to help you get started with your routine:

If you are looking for help in setting up or maintaining a routine with your child, speak with one of the CPA speech pathologists and occupational therapists. They can assist you in building a routine that works for you and your family, and brainstorm solutions to any problems that you may face.